NHCAA Conference: SCIO Health Analytics® to Present Educational Session on Identifying FWA in Compound Medications View as PDF

Healthcare Fraud Expert to Discuss Ways to Reduce Overpayment, Improve Safety at Annual Training Conference

WEST HARTFORD, Conn. – November 8, 2017 – SCIO Health Analytics® today announced that it is hosting an educational breakfast session at the National Health Care Anti-Fraud Association’s Annual Training Conference on steps healthcare organizations can take to identify inaccurate claims and prevent fraud, waste and abuse in compound medications.

The session, titled “Investigating Compound Rx FWA to Contain Costs and Improve Safety,” will be held at 7:45 a.m. on Thursday, November 16, and will be led by Rena Bielinski, SCIO’s senior vice president of strategic accounts.

The past decade has seen dramatic growth in the amount of fraud, waste and abuse, as well as overpayments, related to compounded medications. Although compound medications represent a small portion of overall pharmacy claims, they are associated with a disproportionate amount of errors and waste, compared with traditional claims. Ensuring proper compound procedures, billing accuracy and proper payment for these claim types is often difficult due to data limitations that restrict effective selection, a reliance on manual auditing, and advanced fraudulent techniques used by pharmacies.

In this educational session, Bielinski will discuss how to develop a program to identify inaccurate claims and prevent fraud, waste and abuse via a three-pronged approach of edits and prior authorization; fraud, waste and abuse identification and recovery; and pharmacy education.

In just four months, SCIO’s compound medication program has identified $3.5 million in potential fraud, waste and abuse and recovery, and improved clinical safety by reducing over- and under-dosing. In addition to compound medications and several other areas, SCIO also specializes in reducing overpayments and fraud, waste and abuse in the home health services market.

SCIO’s payment integrity solutions help payers, health plans and PBMs control costs associated with third-party liability and incorrectly billed or overpaid health claims to reduce overall health claim expenditures. SCIO’s medical claim auditing services ensure clients are controlling costs most often associated with incorrect billing and overpaid medical claims, improving both administrative and medical loss ratios. SCIO’s pharmacy claims auditing services focus on pharmacy compliance, overpayment identification, and fraud.

Media contact:
Brandon Glenn
Amendola Communications

SCIO Health Analytics Contact:
Michele Norton, M.S., R.N.
Senior Vice President Marketing